Fatigue and Crohn's Disease: Types, Symptoms, and Treatment

Fatigue is a commonly-reported symptom of Crohn’s disease, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Your experience of fatigue with Crohn’s may depend on your disease’s activity and severity.

A 2010 review of studies on fatigue and IBD found that 41 to 48 percent of people with IBD experience fatigue during remission. Up to 86 percent of people with moderately-to-severely active Crohn’s had fatigue.

A smaller 2019 study of 113 people with IBD supported these findings. Researchers found that the prevalence of fatigue was 39.5 to 44.2 percent in remission and 80 to 82.9 percent during a flare-up.

Contributors to fatigue in Crohn’s disease

There are several factors that can potentially contribute to fatigue in a person with Crohn’s disease. Many of these stem from the complications of Crohn’s or other effects it has on your body, according to the NIDDK.

These include:

• Inflammation. Inflammation is associated with increases in proteins called cytokines. The effects of cytokines can cause fatigue, which can also help explain why fatigue can worsen during a Crohn’s flare.
• Anemia. Some people with Crohn’s have anemia, which means a low red blood cell count. One of the main symptoms of anemia is fatigue. Anemia can happen due to bleeding in the digestive tract or deficiencies in specific nutrients like iron, vitamin B12, or folate.
• Nutrient deficiencies. The effects of Crohn’s disease on the intestines can mean that nutrients aren’t well absorbed in general. This is called malabsorption. Not getting enough nutrients in your diet can cause fatigue.
• Sleep disturbances. People with Crohn’s disease can experience disrupted sleep, particularly during a flare when symptoms worsen. Frequently poor sleep results in fatigue.
• Emotional stress. Coping with a chronic condition like Crohn’s disease can be stressful and even lead to depression. Increased stress levels or being in a depressed state can cause fatigue.
• Medication side effects. Crohn’s disease is typically treated with medication. Certain medications have fatigue as a side effect.

Studies from 2017, 2019, and 2021 have assessed whether certain factors are associated with fatigue in IBD.

The following are associated with an increased likelihood of experiencing fatigue with Crohn’s:

• being a younger age
• being female, or being assigned female at birth
• having Crohn’s disease for a shorter period of time
• engaging in low levels of physical activity
• not getting enough sleep
• having a higher body mass index (BMI)
• experiencing increased pain levels
• having anxiety or depression

It’s important to note that fatigue is complicated and can happen due to many different physical, psychological, and lifestyle factors. Additional research needs to be done to further understand factors that influence fatigue in Crohn’s disease and how they may interact with each other.

Fatigue is a feeling of extreme tiredness or having very low energy. Many people with persistent fatigue find that this feeling isn’t completely relieved by sleep.

People who are experiencing fatigue can have:

• a lack of energy or strength to do even small or simple tasks
• difficulty staying focused or concentrating
• trouble making decisions or remembering things
• a reduced reaction time, which can increase the risk of accidents

As you may expect, the effects of fatigue can impact many aspects of life, such as:

• Daily tasks. Having fatigue can mean it may take longer or require more effort to do daily tasks, such as washing, cooking, or cleaning.
• Work or school. Fatigue can lead to decreased productivity or performance at work or in school.
• Social. It’s possible that people with fatigue may avoid getting together with friends and family due to the amount of effort that feels involved.
• Hobbies. Feeling so exhausted all of the time can mean that activities that were once fun or engaging aren’t as enjoyable anymore.
• Sex. Fatigue can cause some people to have a lower sex drive.

It’s not hard to believe that many people with Crohn’s and fatigue aren’t satisfied with their quality of life. A 2019 study of 544 people with IBD found that individuals reporting fatigue also reported a significantly decreased quality of life.

It’s important to recognize that there are many possible causes of fatigue in addition to, or alongside, inflammatory bowel disease.

For example:

• too much physical activity, or a lack of physical activity
• high levels of emotional stress
• lack of sufficient sleep
• not eating a balanced diet, or nutrient deficiencies
• regular alcohol consumption
• high caffeine intake
• certain types of medications, like antihistamines, antidepressants, or pain medications
• the effects of medical treatments, like surgery, chemotherapy, or radiation therapy

Other health conditions that have fatigue as a primary symptom include:

• viral or bacterial infections
• diabetes
• obesity
• thyroid disease
• sleep apnea
• autoimmune diseases, like rheumatoid arthritis or lupus
• chronic fatigue syndrome
• untreated pain
• anxiety and depression

Determining the cause of your fatigue is important for taking steps to effectively manage it. It’s also possible to have multiple factors that are leading to fatigue.

The goal of Crohn’s disease treatment is to decrease inflammation levels. This can help keep you in remission and prevent flares from occurring.

Crohn’s disease medications

The main type of treatment for Crohn’s is medication, which includes:

• aminosalicylates, such as mesalamine and sulfasalazine
• immunomodulators or immunosuppressive, including azathioprine or 6-mercaptopurine
• biologics, like adalimumab (Humira) and infliximab (Remicade)
• corticosteroids
• antibiotics, such as ciprofloxacin and metronidazole, to treat any abscesses or fistulas in your gastrointestinal tract

Crohn’s disease diet

Dietary modifications are an important part of Crohn’s disease treatment. Your doctor may suggest that you keep a food diary to help identify foods that make your symptoms worse.

Depending on your nutritional needs, they may also recommend a specific diet. Lab tests can be used to test for food intolerance and sensitivities.

Here’s a nutrition guide to help those with Crohn’s disease.

When Crohn’s symptoms are severe, bowel rest may be necessary. This involves only consuming certain types of liquids and not eating or drinking anything else for a period of days.

Hospitalization

Crohn’s disease may require hospitalization if a flare is particularly severe, according to 2020 research. At the hospital, you will likely receive medication infusions to lower systemic inflammation and be monitored continuously by a gastroenterologist.

Factors leading to hospitalization for Crohn’s include:

• blood in stool
• sudden diarrhea and cramping
• fever
• increased heart rate
• signs of malnutrition

Learn more about hospitalization for Crohn’s disease.

Some people with Crohn’s have symptoms that don’t improve with any of the above treatments. Complications like fistulas or bowel obstructions may require surgery.

Treating Crohn’s disease fatigue

Crohn’s disease treatments focus on lowering inflammation and disease activity. Since inflammation contributes to fatigue, effectively managing symptoms may help to reduce or eliminate fatigue for some people with Crohn’s.

Some other ways you can manage fatigue include:

• Increasing physical activity. It may seem counterintuitive, but getting regular exercise can help ease symptoms of fatigue. If you don’t already have an exercise routine, ask your doctor about how to get started.
• Promoting good sleep. Disrupted sleep can make fatigue worse. Take steps to get better sleep by doing things like setting up a regular sleep schedule, doing something relaxing before bed, and avoiding daytime naps.
• Lowering stress. Stress can contribute to fatigue, so it’s important to try to reduce your stress levels. Some examples of things to try include yoga, listening to calming music, or spending time with loved ones.
• Improving your diet. If you eat a diet that’s poor in nutrition, working to improve it may help with fatigue. Try to focus on whole grains, fresh produce, and lean protein sources. Your doctor can provide suggestions based on your individual needs.
• Taking dietary supplements. If you’re not getting enough of certain nutrients, your doctor may recommend taking dietary supplements. Always consult your doctor before taking vitamins or supplements, and make sure they don’t have interaction warnings with your other medications.
• Trying therapy. If fatigue is having a significant impact on your life, cognitive behavioral therapy (CBT) or talk therapy may help you to cope. CBT focuses on identifying counterproductive thought patterns and behaviors and learning how to deal with them. Talk therapy provides a safe space to talk through emotions and experiences.
• Treating other conditions. If you have other health conditions that can lead to fatigue, your doctor will work to treat those as well. Lab tests may be required to rule some things out.
• Evaluating medications. If a medication you’re taking is potentially contributing to your fatigue, your doctor may adjust its dosage or switch you to another medication that doesn’t have fatigue as a side effect.

As you work to manage fatigue, it’s important to be patient. It’s possible that you may need to try multiple strategies or different combinations of strategies to help lower fatigue.

Fatigue is a common symptom of Crohn’s disease. It can result from increased inflammation, anemia, or the nutrient deficiencies that Crohn’s often causes.

Physical, psychological, and lifestyle factors can also contribute to fatigue, especially if you have Crohn’s disease. These include heightened stress levels, poor sleep, and having other health conditions at the same time.

Treating Crohn’s disease with medication and lifestyle adjustments is the best way to manage fatigue. You might be experiencing tiredness and low energy due to other health conditions or life circumstances, in which case treating Crohn’s may not affect fatigue levels.

Fatigue can greatly impact your quality of life and might be a sign that you need to adjust your treatment regimen for Crohn’s disease. Talk with your doctor about options for managing fatigue as a Crohn’s symptom or to determine if your fatigue has a separate cause.